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JOURNAL ARTICLE

Primary peritoneal mesothelioma: How aggressive should we be?

Background:Primary peritoneal
mesothelioma is a rare disease with an unpredictable clinical course.
This has led to a variety of treatment options, ranging from minimal debulking,
debulking with adjuvant intraperitoneal (i.p.) chemotherapy to aggressive
debulking with peritonectomy with hyperthermic intra-operative
i.p. perfusion. It is unclear whether outcome is dependent on treatment,
patient selection or tumor biology.

Methods: A retrospective review of all patients with
primary peritoneal mesothelioma treated at a single institution between
1/1/82-1/1/02 was performed. Patient, tumor and treatment variables were
reviewed.

Results: Thirty-seven pts. with primary peritoneal
mesothelioma were identified. Patients with pleural mesothelioma with
peritoneal extension were excluded. Median follow-up was 49 months (range
3-97mos.) There were 15 male and 22 female pts. with a median age of
56 years. All pts. were explored with the pre-operative goal of maximal
cytoreduction with minimal sacrifice of adjacent organs. Total peritonectomy
was not performed. The adequacy of debulking was grouped into 5 categories
ranging from 0-25% debulked (12 pts.), 26-50% (5 pts.), 51%-75% (1 pt.),
76%-99% (13 pts.) or complete (6 pts.) The overall complication rate
was 30% with 3 post-operative deaths. Thirty pts. (81%) were treated
with adjuvant chemotherapy: 18 pts. received only i.p. chemotherapy,
7 received both i.p. and i.v. chemotherapy and 5 received i.v. chemotherapy
only (7 unknown). The most common i.p. regimen was combined cisplatin/mitomycin
C (17 pts.) (Cancer Res Clin Oncol 1992, 118:547-50). The median overall
survival was 58 months. Twenty-seven pts. felt relief of symptoms as
manifest by decreased pain and/or decreased ascites. Optimally debulked
(76-99% or complete) patients showed improved long-term survival as compared
to those who were sub-optimally debulked (p<0.001). The addition of
i.p. chemotherapy was also associated with significantly improved survival
(p=0.009).

Conclusions: Mesothelioma is a rare but lethal disease.
Long-term survival can be realized in patients that undergo optimal debulking,
without peritonectomy, and receive adjuvant i.p. chemotherapy.